Acetaminophen (Paracetamol) updated on 09-20-2024

ASD (Autism spectrum disorder): Diagnosis/Risk

R analysis
id Study   Lib. in paper Exposition period    Study type  Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18555
R78893
Okubo (Controls unexposed, general population), 2025 Autism spectrum disorder (ASD) - ICD-10 codes (F84 - diagnoses only) - Mean follow up 4.4 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Paracetamol use: prescription or medical files 1.07 [0.98;1.15] -/42,123   -/42,123 - 42,123
ref
S18556
R78900
Okubo (Controls unexposed, sibling), 2025 Autism spectrum disorder (ASD) - ICD-10 codes (diagnoses only) - Mean follow up 4.4 years during pregnancy (anytime or not specified) retrospective cohort (claims database) sibling excluded Adjustment: Yes Control group: Sibling Paracetamol use: prescription or medical files 0.85 [0.64;1.13]
excluded (control group)
-/11,696   -/11,897 - 11,696
ref
S16629
R69725
Ahlqvist (Population-Based), 2024 Autism - ICD-10 (F84) or ICD-9 (299) - Median (IQR) follow-up of 13.4 (7.6-19.8) years during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Paracetamol use: maternal ITW/questionnaires during pregnancy 1.05 [1.02;1.08] 5,912/185,909   62,672/2,294,888 68,584 185,909
ref
S16630
R69731
Ahlqvist (Sibling), 2024 Autism - ICD-10 (F84) or ICD-9 (299) - Median (IQR) follow-up of 13.4 (7.6-19.8) years during pregnancy (anytime or not specified) population based cohort retrospective sibling excluded Adjustment: Yes Paracetamol use: maternal ITW/questionnaires during pregnancy 0.98 [0.93;1.04]
excluded (control group)
3,956/-   41,294/- 45,250 -
ref
S16643
R69862
Liew b, 2016 Autism Spectrum Disorder diagnosis (ICD-10 F84.0-F84.9) - Follow-up 11-17 years old (average 12.7 years) during pregnancy (anytime or not specified) prospective cohort unexposed (general population or NOS) Adjustment: Yes Paracetamol use: maternal ITW/questionnaires during pregnancy 1.19 [1.04;1.35] 626/36,187   401/28,135 1,027 36,187
ref
Total 3 studies 1.07 [1.02;1.13] 69,611 264,219
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Okubo (Controls unexposed, general population), 2025Okubo, 2025 1 1.07[0.98; 1.15]-42,12327%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Ahlqvist (Population-Based), 2024Ahlqvist, 2024 2 1.05[1.02; 1.08]68,584185,90959%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Liew b, 2016Liew b, 2016 1.19[1.04; 1.35]1,02736,18713%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: lowROB mesure: criticalROB reporting: moderate Total (3 studies) I2 = 42% 1.07[1.02; 1.13]69,611264,2190.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, general population; 2: Population-Based;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.07[1.02; 1.13]69,611264,21942%NAOkubo (Controls unexposed, general population), 2025 Ahlqvist (Population-Based), 2024 Liew b, 2016 3 case control studiescase control studies 0 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.07[1.02; 1.13]69,611264,21942%NAOkubo (Controls unexposed, general population), 2025 Ahlqvist (Population-Based), 2024 Liew b, 2016 3 Tags Adjustment   - Yes  - Yes 1.07[1.02; 1.13]69,611264,21942%NAOkubo (Controls unexposed, general population), 2025 Ahlqvist (Population-Based), 2024 Liew b, 2016 3 Paracetamol use   - maternal ITW/questionnaires during ...  - maternal ITW/questionnaires during pregnancy 1.10[0.98; 1.24]69,611222,09670%NAAhlqvist (Population-Based), 2024 Liew b, 2016 2   - prescription or medical files  - prescription or medical files 1.07[0.99; 1.16]-42,123 -NAOkubo (Controls unexposed, general population), 2025 1 All studiesAll studies 1.07[1.02; 1.13]69,611264,21942%NAOkubo (Controls unexposed, general population), 2025 Ahlqvist (Population-Based), 2024 Liew b, 2016 30.55.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

Asymetry test p-value = NaN (by Egger's regression)

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

Sub-groups analysis using all included studies

excluded 16630, 18556

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.07[1.02; 1.13]69,611264,21942%NAOkubo (Controls unexposed, general population), 2025 Ahlqvist (Population-Based), 2024 Liew b, 2016 3 siblingssiblings 0.97[0.92; 1.03]45,25011,6960%NAOkubo (Controls unexposed, sibling), 2025 Ahlqvist (Sibling), 2024 20.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Bérard (Autism Spectrum Disorder (ASD))Bérard (Autism Spectrum Disorder (ASD)) 0.98[0.93; 1.04]NA-SsiblingAnyduring pregnancy (anytime or not specified)studies TTT1 Bérard (Autism Spectrum Disorder (ASD) combin ...Bérard (Autism Spectrum Disorder (ASD) combining diagnosis/risk assessment) 1.10[0.98; 1.24]70%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT2 Masarwa (Autistic spectrum disorder (ASD) and ...Masarwa (Autistic spectrum disorder (ASD) and emotional problems) 1.19[1.14; 1.25]14%-Wwhatever (meta-analysis)Anyduring pregnancy (anytime or not specified)studies TTT5 metaPregmetaPreg 1.07[1.02; 1.13]42%264,219----Okubo (Controls unexposed, general population), 2025 Ahlqvist (Population-Based), 2024 Liew b, 2016 30.510.01.0